Um... Can you hit before you get hit?

[tarotale]

As a 1yr ms RN going into ED, one of the top things that concerns me is the safety. I'm sure you have seen lots of crazy things that happen at ed, and I'm not doubtful that one of them include violence against staff.

I have heard from others that people bring guns to the ed, sometimes you can get punched, kicked, put in choke holds, wrestled like in the octagon, etc.

In my state, we have a law that makes assaults on ed staff a felony, but I don't think that will stop the real crazies. I already have a bad back for which I go to the chiropractor, and I don't want to get disabled.

I understand that the best thing to happen is just avoid the violence when it's happening, but what if I have a coworker who is 5ft and will surely go to Valhalla if I run away? Or what if I'm cornered and have to fight? I be honest with you, if there's two options, one being a saint and risk being disabled for rest of my life or being badly hurt, and the other being "selfish " and knock the snap out of someone so I can support my family, I will happily put someone to sleep as best as I could with the blessings of Rocky Marciano. This is not really something you would worry too much about in MS setting, so I feel apprehensive about it.

As you all know this is my first ed position and I know I will defend myself and my coworkers in violent situations. So the question is probably this: what is the realistic approach in hitting someone before yourself can get hurt bad in ed? I'm not going to just simply start punching pts but I'm taking about real danger situations where you know it's either do something or get hurt.

Many ED nurses I talk to about this said they had to use "rough" methods to avoid having themselves or coworkers from getting badly injured... Or am I worrying about something that happens very very rarely?

[emtb2rn, BSN, RN, EMT-B]

Assume you're talking about fight in progress, not a pre-emptive strike. Call for help, hit the code button, get strength in numbers. That said, punching isn't a great approach unless you actually know how to do it correctly. Take downs are much more effective.

As for hitting first - NO. Never ever be the instigator of a physical encounter. You will have many instances where it'll get oh so close but then the threat of violence is defused.

[MrChicagoRN, RN]

No.

You cannot hit first.

And, you are on legally perilous grounds if you hit back.

you can verbally deescalate, you can respond as a team. You can provide emergency medication, or restrain. You can block, pin, hold, move out of range.

Your concerns are real, but I think overblown.

Ask about receiving CPI Training

here is some info regarding deescalation: http://www.crisisprevention.com

[Carlitos]

Violence in the EC is far from rare, even common. I would say no, do not hit before you get hit. The best thing you can do is learn how to recognize when a patient may become violent BEFORE it happens. That will give you the opportunity to de-escalate the situation before it becomes violent. Sometimes talking to the patient and finding out what they are upset about and/or calling for backup or security as a "show of force" will be enough to prevent a violent situation. Of course there are those patients that are not re-directable and, despite your best efforts, will become violent. In such situations, most facilities have policies regarding how to handle these situations. Know these policies well!!! As a paramedic dealing with these patients we were taught that our safety comes first, our partners safety second, bystander safety 3rd, and the patient's safety last. This prevents adding more patients to the scene. Do what you can to make sure everyone in the area is safe first, protect the patient as much as you can while restraining/subduing. Sometimes the patient will get hurt during a takedown, but it should never be your goal, per se, to inflict pain or injury for the purpose of restraining a violent patient.

[tarotale]

Thanks for the jewels of inputs so far. To be clear on the hypothetical situation upon which my question is based on, let's say the pt/family is being very belligerent and face to face with you yelling and about to strike or crush you down the ground. Of course punching someone at this stage will only make you the instigator and therefore should not be done, but at the moment the fist swings and you duck and you are cornered so nowhere to go, and you know the punches are going to reign upon you, can you strike to make space to get out. No preemptive strike haha.

I guess the basis of my question is in what situations are strikes (implicitly) allowed for your part, or it is not at all and you should stand there and block only possibly end up getting hurt. I understand of the show of numbers, deescalation, etc but I'm talking about those rare situations that happen very quickly and no time to try other peaceful interventions.

I also wonder if any department endorses pepper spray or something like that.

[MrChicagoRN, RN]

Pepper spray...No, No, No

In 30 years, I've never had to hit anyone, even with Very violent patients.

First of all, avoid get cornered. Seriously.

As soon as someone gets beligerant and threatening, you call in the troops Go with your gut, be aware of & and control your environment. Use your team. Use security. Don't allow yourself to get pinned in.

Returning blows may just escalate a situation. Block, pin the arm, push them back a step to create an opening. If hitting or kicking is absolutely the only option available, then you do what you need to, but realize you are accountable for your actions.

[AGACNPTX]

In our ER we took MOAB (management of aggressive behavior). We frequently had violent patients (a lot of psych and drug users). Anytime you think there is potential for a patient to become violent or aggressive take multiple staff members in the room with you. Additionally, insist on accompanying your co workers. Team work is key. We did have nurses who were injured by patients on occasion. I also saw several rough take downs and "rough" treatment of patients, but I never saw anyone flat out punch a patient.

[nurse2033, MSN, RN]

I think your worries are overblown. Retreat, deescalate, block, evade, or make them chase you across the ER. Never place yourself in a vulnerable position unless you have no other choice. There is strength in numbers, recruit a mob to back you up if you need. Hitting a patient, for any reason, is the absolute, rock bottom, last choice, that should be only for life or death situations. There is just no way to make that look good when you go to court.

[Ruby Vee, BSN]

You cannot strike someone. You just cannot. If you're this worried about the possibility of physical violence, perhaps the ED isn't the right job for you.

[ComeTogether, LPN]

Just to be clear, you are asking if it is OK to hit a patient because they might hit you?

[tarotale]

You cannot strike someone. You just cannot. If you're this worried about the possibility of physical violence, perhaps the ED isn't the right job for you.

Well now I have been confirmed by Mr Chicago that actual physical violence doesn't happen as often as it portrayed to be, not sure whether that's true in other ed. I cannot say exactly what, and how the situations pan, but I won't be a victim of violence that I know for sure.

Don't worry, I will have a lot of learning curve in ed but I will do fine and my desire to help a dying person is still greater than my concern of getting punched.

[tarotale]

Just to be clear, you are asking if it is OK to hit a patient because they might hit you?

Just to be clear, u do realize I explained the situation as a case in which pt already started pummeling on u or u dodged the blows and I'm asking if it is realistic for an ED nurse to defend him/herself in that situation right?